Diabetes can be successfully managed through monitoring, medication and lifestyle changes like diet and exercise. The key to successful self-management is developing a care plan that fits a patient’s lifestyle.
The Froedtert & the Medical College of Wisconsin Diabetes Care Center is unique in offering a continuum of care to all patients, whether someone is newly diagnosed or experiencing chronic complications associated with diabetes. The Center offers educational programs and classes to help people with diabetes better understand and manage their disease. In 1988, it was the first program in Wisconsin to receive recognition from the American Diabetes Association for meeting national standards of excellence in diabetes education.
Team members include endocrinologists, nurses who are certified diabetes educators (CDE), registered dietitians (also CDE), and the patient’s primary care physician.
Outpatient Diabetes Management
Froedtert & the Medical College of Wisconsin offers diabetes care at numerous locations. Patients visit with an endocrinologist and certified diabetes educators (nurse and dietitian) for ongoing management of their condition. In addition to teaching patients diabetes self-management, the clinics offer patients the latest diabetes technology, including insulin pumps, self-monitoring glucose meter downloading and on-site rapid AIC measurement.
People who have other health problems associated with diabetes require specialized care. When a patient's condition requires, other Froedtert & the Medical College of Wisconsin physicians, such as ophthalmologists or vascular physicians, are involved in patient care.
Insulin Pump Program
Some patients with diabetes may be candidates for an insulin pump, a device that delivers rapid- or short-acting insulin 24 hours a day through a catheter placed under the skin. The pump provides an alternative to daily injections of insulin and can help keep blood glucose levels within target ranges.
Once patients meet the criteria for a pump, nurses who specialize in pump therapy and continuous glucose monitoring work with patients to ensure their comfort with the pump. After the pump is placed in the body (in an outpatient procedure), patients learn how to use the pump properly.
Inpatient Diabetes Management
Multidisciplinary diabetes teams are dedicated to improving blood sugar control of hospitalized patients. Comprehensive diabetes management and basic diabetes education are provided to all inpatients, targeting blood sugar control during hospitalization, regardless of the severity of the patient’s condition.
Three dedicated teams meet the special needs of inpatients with diabetes:
- Diabetes Management Team, consisting of an endocrinologist, nurse practitioner and physician assistants, provides direct patient care and blood sugar surveillance.
- Diabetes nurse educators teach patients self-management.
- Diabetes Assessments and Resource Team (DAART) provides surveillance and feedback to the Diabetes Management Team for hospitalized patients who take insulin. These patients are at higher risk for complications when hospitalized. This proactive approach, in use hospital-wide, has yielded significant results in better management of patients on insulin.
Patients with diabetes in the Intensive Care Unit benefit from an insulin drip that provides 24-hour insulin administration. Insulin drip calculator software to control the drip was created by Froedtert & the Medical College of Wisconsin endocrinologist Paul Knudson, MD.
Cystic Fibrosis and Complicating Health Issues
Froedtert & the Medical College of Wisconsin endocrinologists are knowledgeable and experienced in treating people with all forms of diabetes, including people who have other health conditions that make diabetes management more challenging.
Cystic fibrosis (CF) and pancreas surgery can affect how the body produces insulin and regulates blood sugars, leading to diabetes. People with diabetes who undergo solid organ transplantation (e.g. receiving a new liver) receive glucocorticoids, which make diabetes management more challenging.
Patients with these health problems have increased insulin needs or insulin sensitivity, and may have special nutrition needs. These patients also tend to require more hospitalization. Froedtert & the Medical College of Wisconsin endocrinologists and other members of the diabetes team follow these patients through the continuum of their care — from outpatient to inpatient. Diabetes care complements and integrates with other teams that care for patients with more challenging forms of diabetes.
Diabetes may occur as the result of many other conditions. Medical College of Wisconsin endocrinologists work with other Medical College specialists to address the unique needs of patients who develop diabetes associated with:
- Recurrent pancreatitis
- Anti-HIV therapy/AIDS patients on highly active anti-retroviral therapy
- Iron overload syndromes
- Medications that can cause complications
- Maturity onset diabetes of youth
- Maturity onset diabetes of youth and pregnancy
- Autonomic nervous system dysfunction
- Diabetic gastroparesis (delay gastric emptying)
- Orthostatic hypotension
- Gustatory sweating
- Macrovascular complications (coronary heart disease, peripheral vascular disease, stroke hypertension, other complications)
- Hypoglycemic unawareness
- Recurrent hypoglycemia
- Diabetic cachexia
- Erectile dysfunction
Care for Complications
Medical College of Wisconsin physicians are also highly experienced in treating patients with complications of Type 1 and Type 2 diabetes, including:
- Microvascular complications
- Diabetic retinopathy
- Peripheral neuropathy
- Diabetic foot ulceration
- Charcot joint
- Diabetic nephropathy
- Chronic kidney disease